Provider Demographics
NPI:1194711960
Name:SITTAMBALAM, EARLE J (MD)
Entity type:Individual
Prefix:DR
First Name:EARLE
Middle Name:J
Last Name:SITTAMBALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-832-8150
Mailing Address - Fax:860-224-6298
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-832-8150
Practice Address - Fax:860-224-6298
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT016540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT476899OtherAETNA
CTP369700OtherOXFORD
CT1255448155OtherGHMC GROUP NPI ID
CT135725OtherWELLCARE MEDICARE
CT01016540OtherCIGNA
CT5321501OtherCONNECTICARE
CT060036OtherHEALTH NET
CT442111236OtherRAIL ROAD MEDICARE
CT001165406Medicaid
CT004214483Medicaid
CT010016540CT01OtherBCBS & BCFP PROV ID
CT110000706Medicare ID - Type Unspecified
CT1255448155OtherGHMC GROUP NPI ID
CT476899OtherAETNA